| NPI | 1942588561 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: CA 57544) |
| Additional Taxonomies | 363AS0400X Physician Assistant Surgical (Licence: NY 014862) |
| Enumeration Date | 2011-07-31 |
| Last Update Date | 2022-02-11 |